Innovating Ways to Cure Diabetes

According to the International Diabetes Federation, the number of people diagnosed with diabetes has increased from 30 million to 246 million over the past two decades. In the Philippines, the Department of Health says that there are currently eight million diabetics, with 500 newly diagnosed everyday.

Due to this surge in numbers, researchers have been doubling their efforts to find the remedy that could help eradicate diabetes. However, in spite of some promising results for two procedures—stem cell therapy and pancreatic islet cell transplant—that long-sought answer for a cure remains evasive.

Stem Cell Therapy: Its Value to the Research Community
An article found in The Mayo Clinic website describes stem cells as “cells from which all other cells with specialized functions are created.” These cells are said to be unique as no other cell in the body has the ability to renew or differentiate by itself. Due to its extraordinary characteristic, stem cells are highly valued by researchers for therapy as they hope to manipulate them into specific types of cells for different illnesses. “If this is done successfully, stem cells may be used to regenerate and repair tissues and organs to treat diseases and conditions such as diabetes, heart failure, Parkinson’s disease, inherited genetic diseases or spinal cord injuries,” according to the Mayo Clinic article.

In addition to that, because of a shortage of donor organs, stem cells are also seen to be grown into organs for transplant. Researchers say that these cells could be used in the testing of experimental medications before they are tested in humans.

Today, researchers have found several sources of stem cells: embryonic stem cells, adult stem cells, adult cells altered to have properties of embryonic stem cells, embryonic germ cells and amniotic fluid stem cells. All of these types of stem cells are under heavy study for their benefits which could one day save millions of people from dreaded diseases. Stem cell transplants have been performed in the United States since the late 1960s, some of which have proved highly successful in treating a number of cancerous diseases such as leukemia, and noncancerous diseases such as aplastic anemia.

Stem Cell Therapy for Diabetes
According to Dr. Susan Yu-Gan of the Philippine Diabetes Association, adult stem cells, specifically mesenchymal stem cells from the bone marrow, are the ones commonly used for therapy. Dr. Yu-Gan explains how this is possible, “You know that stem cells can develop into any type of cell. So when you put these cells into the pancreas it will develop into pancreatic cells, hopefully into beta cells, because that is what is deficient in diabetics.”

She says that by the time of diagnosis, only 50 percent of these beta cells are functioning. Therefore, adding more beta cells will help in the improvement of the diabetes of the person in terms of insulin production. “The advantage of embryonic stem cells is that it could be cultivated and made to develop into the insulin-producing islet cells of the pancreas,” says Dr. Gerry H. Tan of the American Association of Clinical Endocrinologists-Philippine chapter. “And with a ready supply of cultured stem cells at hand, it is therefore plausible that a line of embryonic stem cells could be grown as needed for anyone requiring a transplant.”

Dr. Tan adds, “What is important is that these cells could be engineered to avoid immune rejection which is the most important limitation of organ transplant. Another important advantage of embryonic stem cell is that studies have shown it less to cause an immune rejection.” One more characteristic of stem cells that could prove to be beneficial for diabetes therapy is its potential to reduce insulin resistance. “They also found out that these stem cells inhibit a certain hormone in the body called TNF-Alpha, which promotes insulin resistance, which is the main defect in type 2 diabetes. So aside from increasing insulin secretion the stem cells are able to suppress the TNF-Alpha therefore it can reduce insulin resistance,” says Dr. Yu-Gan.

How It’s Done
Dr. Yu-Gan says that this procedure is done in specialized centers which interested patients could go to. The center would then contact the patient’s doctor directly. Once their doctor has approved of the therapy, patients would have to first undergo a physical examination. “They will do some blood tests to determine if they could undergo the procedure. And once they do the therapy, they will work closely with your personal physician to make sure that everything’s going well,” explains Dr. Yu-Gan.

Here in the Philippines, Dr. Yu-Gan informs that stem cell therapy is already being done. She says that doctors in the country use autologous adipose tissues or one’s own fat cells. “What they do is they culture your adipose tissue to let it multiply, because these tissues would have to be re-injected to the patient every six months.”

Limitations
Doctors agree that stem cell therapy has indeed proven to be a very promising treatment for diabetes. Unfortunately, not everybody can undergo the therapy. Here in the Philippines, those who are candidates for the autologous adipose tissue therapy are those who are deficient in adiponectin. Dr. Yu-Gan explains that adiponectin is a hormone released by fat cells and helps the cardiovascular system. Unfortunately this would mean that the therapy will only work for those who lack the said hormone.

Aside from limiting factors, stem cell therapy can also have its dangers. Dr. Yu-Gan says that stem cells secrete a lot of growth hormones. “If you are harboring any cancer cells, the implanted stem cells can stimulate the growth of these cancer cells,” warns Dr. Yu-Gan. She recommends that patients should have themselves checked for possible cancer cells in their body before undergoing the therapy.

Pancreatic Islet Cell Transplant
Pancreatic islet cell transplant may still be in its experimental stage, however, there has been a reported case of its success. “In a recent study from Edmonton Canada, researchers have reported a 100 percent success rate of seven patients who received islet cell transplants,” shares Dr. Tan. He adds that these patients no longer needed to take insulin, with blood glucose concentrations becoming normal a year after surgery.

“The procedure used an experimental protocol for transplanting islet cells that involved using a much larger amount of islet cells and a different type of immunosuppressant therapy. The so-called Edmonton protocol is now being tested at 10 centers around the world,” says Dr. Tan.

Knowing the Procedure
“Immediately within eight hours of death of a donor, the islets are taken from the pancreas of a deceased organ donor. The islets are then purified, processed, and transferred into another person,” Dr. Tan explains. He also says that pancreatic islet cell transplants are usually done by a specialized radiologist. He says that this is so because the radiologists would have to use, “x-rays and ultrasound to guide placement of a catheter into the upper abdomen and into the portal vein of the liver where the harvested islets are then slowly infused.”

Dr. Tan further explains that the transplant is considered successful if the islets begin to secrete insulin. However, it will take several months before patients are asked to stop taking insulin.

Transplant Risks and Limitations
But like any other transplants, the recipient’s body may also reject the transplanted islet cells—the procedure’s greatest risk. “But then again, in type 1 diabetics, they develop antibodies against their own islet cells, which is the cause of their diabetes,” says Dr. Yu-Gan. This means that the likelihood that these cells will eventually be destroyed is present. “Usually, we give immunosuprressants to reduce the risk of rejection,” she explains.

However, there are also risks in taking immunosuppressants that include, “Mouth sores with associated abnormal white
blood cell counts associated with increased susceptibility to bacterial and viral infections, and gastrointestinal side effects including stomach upset and diarrhea. These drugs can also lead to high blood pressure and anemia, decreased kidney function as well as an increase risk of tumors and cancer,” says Dr. Tan.

However, there are more pressing problems associated with this treatment, says Dr. Tan. “The most important limiting factor of this procedure is the limited supply of organ donors’ tissues. Because of the shortage of organ donors, the waiting list is expected to far exceed available tissues.” Dr. Tan also adds that the islet cells must be obtained from at least two cadavers within eight hours after death to be able to supply enough islet cells that can function and that it must be “immunologically compatible.”

Are We Ready For This?
These procedures may be seen as the hope for a cure for diabetes. Although it’s still a far shot from actually being done, researchers are already doing the best they could to finally give answers. However, for a country that cannot even address some of the most basic neccessities of its people, one may ask whether or not these procedures could one day be done in the Philippines, and whether the Filipino people can actually afford them?

Although stem cell therapy is already being done in the country, Dr. Tan says, “These two procedures will take years to be standard procedures in our country. We need more scientists and researchers who are experts in this field for us to be able to proceed and do the stem cell or islet cell transplantation.”

However, the cost of these procedures could be the ultimate worry of our doctors and patients. Dr. Yu-Gan says that during the research stages, the researchers could still handle the costs. “But then, after it has been developed, I don’t think the majority of the Filipino people would be able to afford it, because even in the United States not everybody could afford it,” she shares.

To this Dr. Tan agrees, “Both procedures are costly, and therefore beyond the reach of a common Filipino. With the availability of affordable medications in our country, most likely majority of Filipinos will not be amenable to subject themselves to such costly and still experimental procedures.

Comments:3

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